An aggressive effort by U.S. officials to weaken an international resolution to promote breast-feeding this year is the latest example of the government taking an industry's side in global public health, advocates said.
This spring, U.S. officials threatened negative trade consequences for Ecuador if the country introduced a resolution to the World Health Assembly to encourage breast-feeding, according to a person familiar with the negotiations who spoke on the condition of anonymity to speak candidly. That person said there had been significant lobbying of U.S. representatives in Switzerland by the infant-formula industry over the issue. Ecuador's Ministry of Health did not reply to a request for comment.
The U.S. delegation introduced a “draft decision” at the World Health Assembly in May that was far less binding and powerful than the resolution Ecuador had been drafting, individuals said. The effort was unsuccessful, because the assembly passed a version of the original resolution introduced by Russia. But that version lacked some of the specific language of the earlier draft that targeted the marketing practices of the breast-milk-substitute industry, according to Elisabeth Sterken, national director of INFACT Canada, a nongovernmental organization that promotes infant and young child nutrition.
“It certainly is blatant and aggressive, and an attack on breast-feeding supports,” Sterken said of the U.S. efforts to weaken the resolution. “That pro-business, anti-public-health agenda has certainly come back.”
On Monday, President Trump pushed back against the idea that the United States opposes breast-feeding, apparently arguing that the Ecuador resolution would have limited access to breast milk substitutes. “We don't believe women should be denied access to formula,” he wrote in a tweet. Trade threats were not made by the Department of Health and Human Services, according to a spokesman. A State Department official denied that the U.S. had threatened "a partner nation related to a World Health Assembly resolution," but added that the U.S. "does not shy away from expressing its disagreement when necessary."
“The United States has a long history of supporting mothers and breast-feeding around the world,” HHS spokeswoman Caitlin Oakley said. “The issues being debated were not about whether one supports breast-feeding.”
But advocates said the incident is a throwback to a time when the U.S. government defied the world to protect the infant-formula industry. In 1981, the World Health Organization passed a code to combat the aggressive advertising of breast milk substitutes and provision of free formula to new mothers, after a rise in infant mortality, malnutrition and diarrhea thought to be related to the use of formula mixed with contaminated water. The United States was the sole dissenting vote, against 118 countries in favor, after an intense lobbying campaign by U.S. makers of infant formula to defeat the provision.
Over the years, U.S. support of breast-feeding has increased and its hostility to the code of marketing restrictions has softened, several nutrition experts said. Which is why the events earlier this year came as such a surprise.
“There is no scientific evidence behind the U.S. position. It simply reflects the fact that corporate sales are more important to the U.S. administration than the well-being of women and children,” said Cesar Victora, a specialist in child health and nutrition at Federal University of Pelotas, Brazil.
Advocates said that U.S. government officials, under multiple administrations, have taken industry-friendly positions. They pointed to the Barack Obama administration's actions to protect the pharmaceutical industry, for example, by threatening funding for the Colombian government's peace deal if the country broke the monopoly the Swiss company Novartis had on the cancer drug, Gleevec.
Even so, critics say the Trump administration is in a league of its own when it comes to politically motivated public-health policies. According to Suzanne Ehlers, president and CEO of reproductive rights organization PAI, the Trump administration has aggressively cut back U.S. support for public-health efforts aimed at women.
The administration has cut all international funding to organizations that offer — or even talk about — abortion to patients. The president’s first proposed budget cut all support for international family planning. In April, administration officials stripped all language about reproductive rights from a major State Department human rights report.
Nevertheless, Ehlers said she is surprised by the administration’s reaction to the breast-feeding measure. “I was even a little taken aback,” she said. “That that’s the issue you would pick to torpedo is crazy to me.”
James Love, director of Knowledge Ecology International, an advocacy group, said that at meetings and discussions with high-level people at the World Health Organization, it has become clear the United States is taking industry positions on a range of issues, from obesity to infectious disease.
“We're bracing ourselves for something quite a bit worse than we've seen in the past,” Love said. “They’re protecting the industry in a wide range of negotiations, from pharmaceuticals to infant formula to regulation of junk food. They’re casting a pretty wide net.”